What happens to my pelvis during pregnancy?

During pregnancy your body produces a hormone called relaxin. Relaxin softens the ligaments (the tough, flexible tissues that connect your bones) in your pelvis and other joints.

It happens for a good reason. Having softened ligaments helps your baby to pass through your pelvis during birth. But it does mean that your joints move more during and just after pregnancy (Bjorkland et al 1999, 2000, Kristiansson 1997, Vleeming et al 2005, Vollestad et al 2012).

What causes pelvic pain?

It's thought that if one side of your pelvis moves more than the other then this can cause pain (Vleeming et al 2005).

Normally, when you lie down, stand up or walk, your pelvis is in a locked, or stable, position. If you have pelvic pain, you're probably doing these activities with a less stable, or unlocked, pelvis (Hungerford et al 2004). The result is irritated joints and pain.

These sorts of discomforts are a common feature of pregnancy. About half of all mums-to-be and about a quarter of women who are already mums are thought to have some sort of back or pelvic pain in pregnancy (Wu et al 2004, Vleeming et al 2005).

What is pelvic girdle pain (PGP)?

Pain at the back of the pelvis is known as pelvic girdle pain (PGP). It is sometimes also called sacroiliac joint (SIJ) pain. The sacroiliac joint, at the back of your pelvis, is where problems can arise.

If you feel pain on or around your pubic bone at the front, you may have symphysis pubis dysfunction (SPD), a condition to do with ligaments in another part of your pelvis.

What are the symptoms of PGP?

The pain is often one-sided and may be concentrated in your buttocks (Sturesson et al 1997). It may appear to jump from side to side or be accompanied by a general back pain or pain at the front of your pelvis.

PGP can send shooting pains into your buttocks or down the back of your legs. You may also have pain in your hips. One or both of your legs may feel very weak and you may not be able to lift your legs, particularly when lying down (Mens et al 1999).

What makes the pain worse?

The pain is usually made worse by lying on your back, turning over in bed, walking and standing from a sitting position. PGP is often worse at night, particularly if you've been very active during the day. Moving your legs apart, especially when sitting in a slumped position or lying down, can be painful.

If you experience PGP in one pregnancy, it is more likely to recur earlier in your next pregnancy, and without treatment, may be more severe (Bjelland et al 2010). Health professionals advise letting the symptoms from one pregnancy settle before trying for another baby.

Your physiotherapist should examine your back and hips to make sure the problem is not coming from these joints. She'll take a detailed look at how the muscles of your tummy, back, pelvis and hip are working together.

Your physiotherapist can carry out tests to estimate how long your pain will last after the birth of your baby (Robinson et al, 2010).

How is PGP treated?

You can try a number of tactics:

Be careful during every-day activities. Your physiotherapist can show you how to lock out your pelvis during painful movements such as walking or standing up.

You may be given a pelvic support belt. These can give immediate relief and can be worn safely during pregnancy (Mens et al 2006, Ostgaard et al 1994, Vleeming 1992).

Exercises, especially for the tummy and pelvic floor, improve the stability of your pelvis and back (Gustafsson & Nilsson-Wikmar 2008).

Will having PGP affect my labour?

With the right advice, it is rare for PGP to cause problems in labour. If possible, try not to lie on your back to give birth. Upright or kneeling positions protect your pelvic joints and are generally more comfortable.

If you have to sit on the bed during labour, sitting as upright as possible makes parting your legs easier (ACPWH 2007).

It may be worth discussing with your midwife or doctor which positions would be best in case you need an assisted birth. If you have an assisted birth, you'll be asked to lie on your back and may have your legs in stirrups. Read our expert question on SPD in labour for more information.

If you're in severe pain, and can't move much, you may be offered a caesarean section. This really would be a last resort (Vermani et al 2010).

How soon will PGP go away?

In a few cases, PGP can linger after birth (Vleeming et al 2005). If it does, you can help yourself to recover by carrying on with your treatment (Ostgaard et al 1994). You're unlikely to have pain that persists. You, may, however, have a mild recurrence just before your period. Hormones released at this time can have a similar effect to relaxin.

What can I do to help myself?

If you find turning over in bed very painful, pull your knees as far towards your chest as your bump will allow. Then try sitting up directly from lying on your back. This moves your pelvis from an unstable to a locked position. Tighten your pelvic floor and lower tummy muscles before moving.

Avoid lying on your back or sitting slumped, particularly with your legs straight. It's particularly easy to slip into this position when you're on the sofa or in the bath. If you do have to lie on your back, place a rolled towel under your back, at waist level and bend your knees.

Try not to push through pain. If something hurts, if possible, don't do it. If this type of pain is allowed to flare up, it can take a long time to settle down again.

When you are walking, arch your back and swing your arms as though you are marching. This locks your pelvis in a stable position and activates the muscles that stiffen your joints.

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Comments

I am now in week 38 of my second pregnancy. At around week 30, I started with real pain in my back. Im was fine when I was sat down but as soon as I moved - i.e walked, turned over in bed etc it varied from painful to excruciating.
I don't like to self diagnose but I should have gone with my instinct. I had developed PGP, this did not happen in my first and generally I am fit and well. In this respect the NHS proved to be inadequate, with very little support and conflicting messages.
I went to a general osteopath who did not solve the problem.
In the end I read most of the Pelvic Partnership Website, joined and then got their list of practitioners who specialise in this area.
I went to the nearest one and within 45 minutes I could walk (I almost felt like dancing in fact). This was after 6 weeks of increasing pain.
If you think you have PGP, go find and see a specialist, pay for the treatment if needs be as the value is priceless. Good Luck!

Hi I'm 28 weeks pregnant and this is my forth. first tym being pregnant with a boy. Jst wondering when Im laying on my right side y is he pushing on the right side of my tummy and my hip bone and it's really really sore?

Hi, I'm 18 weeks Pregnant and was diagnosed with pcp. I wore my tube grip support for this first time today. Had no pain all day until about an hour ago. server belly pains started like period pain and down my left side into my thigh. Could this pain br from the tube grip? I've taken it off and pain has subsided, still there but noway near as bad. Has anyone experienced this with the girdle?
Xxx

I think I'm pregnant 4-5 weeks, and I have unbearable pain in my lower back and buttocks. I haven't even moved today. Keel thinking I should ring an ambulance, it's so bad. I had this sciatica when I was pregnant with my 2 children is there any thing I can do? Plz help!!!!!

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